• Benefits, Discovery Plan, prosthetics, Scheme Plans

Discovery Classic Priority: prosthetic benefits (2026)

Contents:

This page has information on: Costs and Prosthetics for Discovery Classic Priority

Terminology:

  • PMBs: Prescribed Minimum Benefits. You can read more about PMBs, see a list of all PMB conditions or read more what "PMB only" benefit means.
  • DSPs: Designated Service Providers. Where stipulated, you must use specific providers to get full benefit.
  • Co-payment: Paid out of pocket, or out of savings account. Sometimes this is refundable to you if you have a gap product.
  • All schemes have extensive exclusions. We've tried to list the non-common ones here, but please consult your scheme or broker to get the full list.

Monthly Costs (2026)

(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)

Discovery:Classic Priority (2026)
Main member: Adult member: Child member:
Total Cost pm:
  • R6,198
  • R4,889
  • R2,478
Savings:
  • R17,376
  • R13,704
  • R6,948
Self Payment Gap:
(What you need to pay out of pocket before you can access the "Above Threshold" benefit)
  • R9,784
  • R6,706
  • R2,102
"Above Threshold" benefit (ATB):
Additional cover the scheme makes available to you, once you've paid the self payment gap.
  • R20,080
  • R14,330
  • R7,020
Children Rates:
  • Under 21yrs
  • Only pay for 3 children
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Prosthetics benefits (2026):

(Other benefits: Costs | Inhospital | Out of hospital | Medication | Maternity | Cancer | Mental Health | Dentistry | Optometry | Other/Extra Benefits | Wellness | Prosthetics)

Discovery: Classic Priority
Assume scheme pays all these costs, unless otherwise stated
Overall Limit:
  • Covered, subject to authorisation
  • Prosthetics required for PMB conditions are always paid in full by scheme, with no co-payment, if you follow the protocols. More info here
 Gap Cover:
Can cover most co-payments and increase sublimits
(Plans coming soon)
Sub-limits:
  • Shoulder joint prostheses: no limit, unless you use non-network supplier, then R50,000 limit
  • Hip and knee joints surgery: no limit, unless you use non-network supplier, then 80% scheme rate and R31,850 per prosthesis limit
  • Prosthetic devices used in spinal surgery: no limit, unless you use non-network supplier, then R24,250 limit for first level and R48,550 for two or more levels. Limited to one procedure per person per year.
  • Spinal surgery: no limit, unless you use non-network supplier, then 80% scheme rate
 Gap Cover:
Can cover most co-payments and increase sublimits
(Plans coming soon)
Note:
  • PMBs: Prescribed Minimum Benefits. PMBs cannot have sublimits or co-payments if protocols are followed. You can read more about PMBs here.
  • DSPs: Designated Service Providers. Where stipulated, you must use specific providers to get full benefit.
  • Co-payment: Paid out of pocket, or out of savings account. Sometimes this is refundable to you if you have a gap product.
    Important!
  • Unless specified, assume that all benefits are paid at 100% scheme rate.
  • No limits or co-payments can apply to treatment of PMBs, which is always unlimited, although subject to strict protocols and scheme rules.
  • "Unlimited" benefits are still subject to authorisation, protocols and sublimits.
  • Assume that all benefits need to be pre-authorised.
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